RESUMO
OBJECTIVE: Behavioral economic research suggests that increasing the salience of a delayed reward may improve capacity for delaying gratification and increase behavior allocated toward obtaining larger, delayed substance-free reward rather than smaller, more immediate reward such as alcohol use. This study aimed to improve the efficacy of outpatient alcohol use disorder (AUD) treatment by adding elements that target behavioral economic mechanisms of change. METHOD: Forty-one (N = 41) adults in outpatient AUD treatment were recruited and 37 participants were retained at follow-up. Following baseline assessment, participants received either the Substance Free Activity Session (SFAS), a single-session behavioral economic-informed intervention focused on increasing future orientation and engagement in values-based substance-free activities or a health education control intervention. Participants in both conditions received weekly prompts (via text or email) relevant to their respective intervention for four weeks. Participants (68.3% male; 70.7% Caucasian, M age = 38.24, SD = 12.69) reported an average of 3.95 (SD = 4.72) binge drinking episodes (4/5 drinks per occasion for a woman/man) and 5.05 (SD = 5.32) drinks per drinking day 30-days prior to treatment entry. RESULTS: The study provided initial support for the feasibility and acceptability of implementing the SFAS within a treatment setting. Participants reported high levels of satisfaction with the SFAS (M = 9.08 (SD = 0.94), on a scale of 1-10). At 3-month follow-up, the SFAS was associated with reductions in the proportion of activity participation and enjoyment (reinforcement) related to substance-use relative to substance-free activities and in alcohol demand compared to control. CONCLUSION: These preliminary results provide initial support for targeting behavioral economic mechanisms of change in an outpatient AUD treatment with a single-session intervention plus remote delivery of booster prompts.
Assuntos
Alcoolismo , Economia Comportamental , Adulto , Consumo de Bebidas Alcoólicas , Alcoolismo/terapia , Feminino , Humanos , Masculino , Projetos Piloto , Reforço PsicológicoRESUMO
BACKGROUND: Young adults typically drink in social settings and report high levels of episodic heavy drinking despite a range of adverse consequences. Behavioral economics posits that this may reflect a reinforcer pathology in which alcohol is overvalued relative to other reinforcers. Theoretically, the value of alcohol is related to both the direct pharmacological effects of alcohol (euphoria, sedation) and the associated social reinforcement, but to date no studies have differentiated the value of social vs. solitary drinking. The current study examines two modified hypothetical alcohol purchase tasks (APTs), one explicitly social and one explicitly solitary, in order to quantify the reward value of social vs. solitary drinking and to determine whether there are unique clinical correlates of solitary alcohol demand. METHODS: Participants were young adults (N = 274, Mage = 25.15, SD = 4.10) recruited from Mturk and from a university subject pool. Participants completed a solitary and social APT, in addition to measures of alcohol consumption and problems. RESULTS: Participants reported significantly greater demand in the social APT compared to the solitary APT across all demand indices. Elevated solitary and social demand were associated with elevated levels of alcohol use and problems. Using a residualized change approach, solitary demand amplitude (maximum consumption and expenditure) and persistence (price sensitivity) contributed additional variance above and beyond their social APT composite counterparts in predicting typical drinks per week and the self-care, academic/occupational, and physical dependence subscales of the YAACQ. CONCLUSIONS: The presence of peers increases alcohol demand compared to a solitary scenario, and greater relative solitary drinking demand may be a risk factor for greater alcohol consumption and problems.
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Consumo de Bebidas Alcoólicas/psicologia , Consumo Excessivo de Bebidas Alcoólicas/psicologia , Reforço Psicológico , Recompensa , Comportamento Social , Adulto , Transtornos Relacionados ao Uso de Álcool/psicologia , Economia Comportamental , Feminino , Humanos , Masculino , Adulto JovemRESUMO
Alcohol use is highly comorbid with depression, especially among college students, whose rates of both phenomena are higher than in the general population. The self-medication hypothesis (i.e., alcohol use is negatively reinforced via the alleviation of negative affect) has dominated explanatory models of comorbidity. However, self-regulation has also demonstrated cross-sectional relationships with both depression and alcohol problems and may contribute to the development of alternative comorbidity models. Self-regulation introduces three alternative models that can be tested empirically: (a) a depressed regulation model, (b) a central nervous system depressant model, and (c) a self-regulatory failure model. The purpose of this study was to test the utility of these models (in addition to the self-medication hypothesis) by examining the temporal precedence in the relations between self-regulation, depressive symptoms, and alcohol problems among heavy-drinking college students (N = 393) over 5 assessment points (baseline, 1 month, 6 months, 12 months, and 16 months) using an autoregressive cross-lagged model. Lower self-regulation, and higher alcohol problems and depressive symptoms, prospectively predicted higher depressive symptoms. Higher alcohol problems and lower self-regulation prospectively predicted higher alcohol problems. Only self-regulation prospectively predicted self-regulation. These results were consistent across multiple time points. Findings are consistent with a self-regulatory failure model of depressive symptoms and alcohol problems. Therefore, self-regulation may be an important etiological variable and potential intervention target to reduce both alcohol problems and depressive symptoms among college students. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Consumo de Álcool na Faculdade , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Depressão/epidemiologia , Autocontrole , Adolescente , Adulto , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Adulto JovemRESUMO
Mental health systems need scalable solutions that can reduce the efficacy-effectiveness gap and improve mental health outcomes in community mental health service settings. Two major challenges to delivery of high-quality care are providers' fidelity to evidence-based treatment models and children's and caregivers' engagement in the treatment process. We developed a novel, tablet-based application designed to enhance via technology the quality of delivery of trauma-focused cognitive-behavioral therapy (TF-CBT). We piloted its use in four community mental health service organizations using a blocked randomized controlled trial to examine the feasibility of implementing tablet-facilitated TF-CBT versus standard TF-CBT with 13 providers and 27 families. Provider fidelity and child engagement in treatment were observationally measured via session audio recording. Parent and child perceptions of the tablet application were assessed using structured interviews and mixed-method analyses. Providers actively and appropriately used tablet TF-CBT to facilitate treatment activities. Providers and families expressed high satisfaction with its use, demonstrating acceptability of this approach. Youth and caregivers in both conditions reported high alliance with their providers. Overall, we found that tablet-facilitated treatment is accepted by providers and families and may be integrated into mental health treatment with minimal training. Further study is needed to examine the extent to which technology-based applications may enhance the reach, quality, and clinical outcomes of mental health treatment delivered to children and families.
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Saúde Mental/normas , Transtornos do Neurodesenvolvimento/psicologia , Transtornos do Neurodesenvolvimento/terapia , Qualidade da Assistência à Saúde/normas , Terapia Assistida por Computador/normas , Adolescente , Adulto , Criança , Terapia Cognitivo-Comportamental/métodos , Terapia Cognitivo-Comportamental/normas , Feminino , Humanos , Masculino , Pais , Projetos Piloto , Psicoterapia/métodos , Psicoterapia/normas , Terapia Assistida por Computador/métodos , Resultado do TratamentoRESUMO
OBJECTIVE: Driving after drinking (DAD) among college students remains a significant public health concern and is perhaps the single riskiest drinking-related behavior. Counselor-delivered and web-based Brief Alcohol Interventions (BAIs) have been shown to reduce DAD among college students, but to date no study has evaluated the efficacy of a single-session mobile phone-based BAI specific to DAD. The present study examined whether a driving-specific BAI delivered via mobile phone would significantly decrease DAD among college students compared to an informational control. METHOD: Participants were 84 college students (67.1% women; average age = 23; 52.4% White) who endorsed driving after drinking two or more drinks at least twice in the past 3 months. After completing baseline measures, participants were randomly assigned to receive either (a) DAD information or (b) DAD mobile BAI that included personalized feedback and interactive text messaging. Participants completed outcome measures at 3-month follow-up. RESULTS: Repeated-measures mixed modeling analyses revealed that students receiving the mobile phone-based BAI reported significantly greater reductions in likelihood of DAD (three or more drinks) and the number of drinks consumed before driving than students in the information condition at 3-month follow-up. CONCLUSIONS: These findings provide preliminary support for the short-term efficacy of a mobile phone-based BAI for reducing DAD among college students.
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Consumo de Álcool na Faculdade/psicologia , Dirigir sob a Influência/prevenção & controle , Dirigir sob a Influência/psicologia , Retroalimentação Psicológica , Estudantes/psicologia , Envio de Mensagens de Texto , Adolescente , Adulto , Condução de Veículo/psicologia , Telefone Celular/tendências , Aconselhamento/métodos , Aconselhamento/tendências , Dirigir sob a Influência/tendências , Retroalimentação Psicológica/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Projetos Piloto , Envio de Mensagens de Texto/tendências , Adulto JovemRESUMO
Heavy drinking among college students in the United States is common and results in a wide range of problems. Symptoms of depression are also common among college students and may exacerbate problems associated with heavy drinking, but to date most studies have been cross sectional and relied on an aggregate measure of alcohol problems. Further, depressive symptoms may also predict other elements of risk among heavy drinkers, including greater experience of substance-related reinforcement, and diminished experience of substance-free reinforcement. The current study examines depressive symptoms as a prospective predictor of changes in alcohol problem domains and reward variables in a sample of heavy drinking college students. Heavy drinking college students (N = 138) completed a survey assessing depressive symptoms, alcohol problems, and reinforcement at baseline and after a 12-month follow-up period. Multiple regressions examined the utility of depressive symptoms (DASS-21) in predicting alcohol problems, substance-related reinforcement, and substance-free reinforcement at the 12-month follow-up after controlling for baseline drinking level and the baseline level of the relevant outcome variable. Baseline depressive symptoms predicted 12-month alcohol problems related to impaired control (i.e., drinking more than planned), self-perception, and self-care. Depressive symptoms also predicted lower 12-month substance-free, but not substance-related, reinforcement. Finally, change in depressive symptoms was associated with total alcohol problems, impaired control, self-perception, self-care, academic/occupational, and physiological dependence problems at 12-month follow-up. Heavy drinkers with depressive symptoms may benefit from interventions targeting alcohol problems that also increase access to and engagement in rewarding alternative activities. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Consumo de Álcool na Faculdade/psicologia , Intoxicação Alcoólica/psicologia , Depressão/psicologia , Reforço Psicológico , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , Estudantes/psicologia , Adulto JovemRESUMO
Behavioral economic theory suggests that increased engagement in constructive, substance-free activities that are in the service of long-term goals (e.g., college graduation, career development, health) can decrease alcohol use and related problems. However, engaging in activities such as these in the high-risk college environment requires the ability to self-regulate by avoiding rewarding but risky behaviors (e.g., drinking) while also effectively organizing behavior in the pursuit of delayed academic and career-related rewards. The current secondary data analyses evaluated self-regulation as a potential mechanism of behavior change in an alcohol intervention trial that compared a standard alcohol-focused brief motivational intervention (BMI) plus a behavioral economic substance-free activity session (SFAS) with an alcohol BMI plus relaxation training (reaction time [RT]) session (Murphy et al., 2012). Participants were 82 first-year undergraduate students (50% women; Mage = 18.5, SD = .71) who reported 2 or more past-month heavy drinking episodes. After completing a baseline assessment and an individual alcohol-focused BMI, participants were randomized to either the SFAS or the RT session. The BMI + SFAS condition reported greater mean self-regulation at 1 month compared with BMI + RT. Furthermore, self-regulation at 1 month significantly mediated the relation between condition and alcohol-related outcomes at 6-month follow-up. Although preliminary, these results suggest that brief behavioral economic intervention elements that an attempt to increase future goal pursuit and substance-free activities can enhance the short-term efficacy of standard alcohol BMIs and that this effect may be due in part to increases in self-regulation. (PsycINFO Database Record
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Consumo de Álcool na Faculdade/psicologia , Economia Comportamental , Recompensa , Autocontrole/psicologia , Estudantes/psicologia , Adolescente , Feminino , Seguimentos , Humanos , Masculino , Motivação , Assunção de Riscos , Resultado do Tratamento , Universidades , Adulto JovemRESUMO
BACKGROUND: Heavy drinking among college students is a significant public health concern that can lead to profound social and health consequences, including alcohol use disorder. Behavioral economics posits that low future orientation and high valuation of alcohol (alcohol demand) combined with deficits in alternative reinforcement increase the likelihood of alcohol misuse. Despite this, no study has examined the incremental utility of all 3 variables simultaneously in a comprehensive model. METHODS: This study uses structural equation modeling to test the associations between behavioral economic variables-alcohol demand (latent), future orientation (measured with a delay discounting task and the Consideration of Future Consequences [CFC] scale), and proportionate substance-related reinforcement-and alcohol consumption and problems among 393 heavy drinking college students. Two models are tested as follows: (i) an iteration of the reinforcer pathology model that includes an interaction between future orientation and alcohol demand; and (ii) an alternative model evaluating the interconnectedness of behavioral economic variables in predicting problematic alcohol use. RESULTS: The interaction effects in Model 1 were nonsignificant. Model 2 suggests that greater alcohol demand and proportionate substance-related reinforcement are associated with greater alcohol consumption and problems. Furthermore, CFC was associated with alcohol-related problems and lower proportionate substance-related reinforcement but was not significantly associated with alcohol consumption or alcohol demand. Finally, greater proportionate substance-related reinforcement was associated with greater alcohol demand. CONCLUSIONS: Our results support the validity of the behavioral economic reinforcer pathology model as applied to young adult heavy drinking.
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Consumo de Álcool na Faculdade/psicologia , Consumo Excessivo de Bebidas Alcoólicas/psicologia , Consumo Excessivo de Bebidas Alcoólicas/tendências , Economia Comportamental/tendências , Modelos Psicológicos , Estudantes/psicologia , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Reforço Psicológico , Universidades/tendências , Adulto JovemRESUMO
Behavioral economic measures of alcohol reward value and future orientation have received support as predictors of alcohol consumption, alcohol-related problems, and response to intervention. Protective behavioral strategies (PBS) have been shown to be a significant mediator between a variety of risk factors and alcohol-related problems. The current article examines direct and mediating associations between measures of alcohol reward value (proportionate substance-related activity participation and enjoyment) and future orientation, use of PBS, and alcohol-related problems. Participants were 393 undergraduates (39.2% male, 78.9% Caucasian) who reported at least 2 past-month binge drinking episodes (5 and 4 drinks for men and women, respectively). This study is a secondary analysis of data collected previously as part of a brief intervention study. Alcohol reward value and future orientation were significantly associated with both protective behavioral strategies and alcohol problems. PBS was a significant partial mediator between these variables and alcohol-related problems after controlling for gender, level of alcohol consumption, and sensation seeking. This study provides support for the hypothesis that high levels of reinforcement from alcohol relative to alternatives and low consideration of the future may lead to patterns of dysregulated drinking with few harm-reduction strategies that increase risk for alcohol problems. In addition to directly targeting PBS, brief alcohol interventions for college students should attempt to increase future orientation and substance-free activities. (PsycINFO Database Record
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Consumo de Álcool na Faculdade/psicologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Etanol/farmacologia , Fatores de Proteção , Recompensa , Adolescente , Transtornos Relacionados ao Uso de Álcool/economia , Etanol/economia , Feminino , Humanos , Masculino , Fatores de Risco , Adulto JovemRESUMO
Symptoms of posttraumatic stress (PTS) show significant comorbidity with alcohol use, but little is known about the mechanisms that might account for this comorbidity. Deficits in reward functioning have long been implicated in alcohol misuse and more recently in PTS reactions, but no study has examined whether reward deprivation may serve as a transdiagnostic risk factor for comorbid PTS-alcohol misuse. The current cross-sectional study sought to test the behavioral economic hypothesis that reward deprivation would be related to both PTS symptoms and alcohol problems, and would mediate the relation between PTS symptoms and alcohol problems in college students. We recruited a diverse sample of urban college students (N = 203, Mage = 21.5 years, SD = 5.5; 79.5% female; 56.8% White, 28.1% Black, .9% Asian, 9.8% Multiracial) who endorsed both alcohol use and PTS symptoms. Reward deprivation (lack of access to, and ability to, experience reward) was related to alcohol problems, and a lack of access to reward was related to PTS symptoms. Furthermore, reward access mediated the relation between PTS symptoms and alcohol problems and craving, after controlling for alcohol use, age, gender, and race. These data provide preliminary support for behavioral economic models of alcohol comorbidity and suggest that treatments for combined PTS and alcohol misuse should attempt to reduce barriers to accessing natural rewards. (PsycINFO Database Record
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Consumo de Bebidas Alcoólicas , Recompensa , Transtornos de Estresse Pós-Traumáticos , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Comorbidade , Estudos Transversais , Desvalorização pelo Atraso , Economia Comportamental , Feminino , Humanos , Masculino , Modelos Psicológicos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto JovemRESUMO
College student drinking is a major public health concern and can result in a range of negative consequences, from acute health risks to decreased academic performance and drop out. Harm reduction interventions have been developed to reduce problems associated with drinking but there is a need to identify specific risk/protective factors related to academic performance among college drinkers. Behavioral economics suggests that chronic alcohol misuse reflects a dysregulated behavioral process or reinforcer pathology-alcohol is overvalued and the value of prosocial rewards are sharply discounted due, in part, to their delay. This study examined delay discounting, consideration of future consequences (CFC) and protective behavioral strategies (PBS) as predictors of academic success (grade point average; GPA) and engagement (time devoted to academic activities) among 393 college drinkers (61% female). In multivariate models, PBS were associated with greater academic engagement, but were not with academic success. Lower discounting of delayed rewards and greater CFC were associated with both academic success and engagement among drinkers. Previous research suggests that future time orientation is malleable, and the current results provide support for efforts to enhance future time orientation as part of alcohol harm-reduction approaches. (PsycINFO Database Record
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Consumo de Álcool na Faculdade/psicologia , Consumo de Bebidas Alcoólicas/epidemiologia , Desvalorização pelo Atraso , Estudantes/estatística & dados numéricos , Desempenho Acadêmico , Adolescente , Adulto , Alcoolismo/epidemiologia , Feminino , Redução do Dano , Humanos , Masculino , Recompensa , Universidades , Adulto JovemRESUMO
BACKGROUND: Elevated depression and stress have been linked to greater levels of alcohol problems among young adults even after taking into account drinking level. This study attempts to elucidate variables that might mediate the relation between symptoms of depression and stress and alcohol problems, including alcohol demand, future time orientation, and craving. METHODS: Participants were 393 undergraduates (60.8% female, 78.9% White/Caucasian) who reported at least 2 binge-drinking episodes (4/5+ drinks for women/men, respectively) in the previous month. Participants completed self-report measures of stress and depression, alcohol demand, future time orientation, craving, and alcohol problems. RESULTS: In separate mediation models that accounted for gender, race, and weekly alcohol consumption, future orientation and craving significantly mediated the relation between depressive symptoms and alcohol problems. Alcohol demand, future orientation, and craving significantly mediated the relation between stress symptoms and alcohol problems. CONCLUSIONS: Heavy-drinking young adults who experience stress or depression are likely to experience alcohol problems, and this is due in part to elevations in craving and alcohol demand, and less sensitivity to future outcomes. Interventions targeting alcohol misuse in young adults with elevated levels of depression and stress should attempt to increase future orientation and decrease craving and alcohol reward value.
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Consumo de Álcool na Faculdade/psicologia , Fissura , Depressão/psicologia , Orientação , Estresse Psicológico/psicologia , Estudantes/psicologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Consumo Excessivo de Bebidas Alcoólicas/psicologia , Fissura/fisiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Previsões , Humanos , Masculino , Orientação/fisiologia , Estresse Psicológico/epidemiologia , Adulto JovemRESUMO
The present study aimed to utilize a Receiver Operating Characteristic (ROC) approach in order to improve clinical decision-making for adolescents at risk for the development of psychopathology in the aftermath of a natural disaster. Specifically we assessed theoretically-driven individual, interpersonal, and event-related vulnerability factors to determine which indices were most accurate in forecasting PTSD. Furthermore, we aimed to translate these etiological findings by identifying clinical cut-off recommendations for relevant vulnerability factors. Our study consisted of structured phone-based clinical interviews with 2000 adolescent-parent dyads living within a 5-mile radius of tornados that devastated Joplin, MO, and northern Alabama in Spring 2011. Demographics, tornado incident characteristics, prior trauma, mental health, and family support and conflict were assessed. A subset of youth completed two behavioral assessment tasks online to assess distress tolerance and risk-taking behavior. ROC analyses indicated four variables that significantly improved PTSD diagnostic efficiency: Lifetime depression (AUC = .90), trauma history (AUC = .76), social support (AUC = .70), and family conflict (AUC = .72). Youth were 2-3 times more likely to have PTSD if they had elevated scores on any of these variables. Of note, event-related characteristics (e.g., property damage) were not related to PTSD diagnostic status. The present study adds to the literature by making specific recommendations for empirically-based, efficient disaster-related PTSD assessment for adolescents following a natural disaster. Implications for practice and future trauma-related developmental psychopathology research are discussed.
Assuntos
Comportamento do Adolescente/psicologia , Tomada de Decisão Clínica/métodos , Desastres , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Tornados , Adolescente , Alabama , Criança , Feminino , Humanos , Masculino , MissouriRESUMO
BACKGROUND: Reward deprivation has been implicated in major depressive disorder and severe substance abuse, but its potential relation to alcohol use disorder (AUD) symptoms in non-treatment-seeking young adult drinkers is less clear. Depression is often comorbid with alcohol misuse, so relations of AUD with reward deprivation might be due in part to the presence of depressive symptoms in young adults. Behavioral economic theory views addiction as a state that is related in part to deficits in drug-free rewards, and therefore requires an investigation into whether reward deprivation has a direct relation to alcohol misuse that is, at least partially, independent of mood. METHODS: This study evaluates the contribution of 2 facets of reward deprivation (reward availability and experience) to alcohol use, AUD symptoms, and depression in a sample of young adult heavy episodic drinkers. Data were collected from 392 undergraduates (60.4% female, 85.1% Caucasian) who reported recent heavy drinking (83.7% with at least 1 AUD symptom). RESULTS: Low reward availability (environmental suppression) was significantly associated with both DSM-5 AUD symptoms and alcohol-related problems after controlling for age, gender, depressive symptomatology, and drinking level. CONCLUSIONS: This study provides support for behavioral economic models that emphasize reward deprivation as a unique risk factor for AUD that is independent of mood and drinking level. Limited access to natural rewards may be a risk and/or maintaining factor for AUD symptoms in college student drinkers.
Assuntos
Consumo de Álcool na Faculdade/psicologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Depressão/psicologia , Recompensa , Adolescente , Transtornos Relacionados ao Uso de Álcool/complicações , Depressão/complicações , Economia Comportamental , Feminino , Humanos , MasculinoRESUMO
Perceived parental stress has been consistently shown to negatively impact child functioning and ability to cope with stressful situations. Utilizing data from the parenting our children to excellence program, the current study examined the relationships among perceived parenting stress, coping competence, and school readiness in a sample of African American and Caucasian parents of preschool children (age 3-6) considered at high risk for child physical abuse. We hypothesized that child competence would mediate the relation between perceived parental stress and children's school readiness. We tested a longitudinal latent variable model and found that parent-reported (but not teacher-reported) child competence mediated the relation between perceived parental stress and school readiness, controlling for family income, parent's education level, and child's sex. These results suggest that parents' perceived stress plays a role in both how they view their children's competence and how children perform academically.
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BACKGROUND: Children need access to high quality mental health care. Effective treatments now exist for a wide range of mental health conditions. However, these interventions are delivered with variable effectiveness in traditional mental health service settings. Innovative solutions are needed to improve treatment delivery quality and effectiveness. OBJECTIVE: The aim of this study was to develop a scalable, sustainable technology-based approach to improve the quality of care in child mental health treatment. METHODS: A tablet-based resource was developed with input from mental health training experts, mental health providers, and patients. A series of qualitative data collection phases (ie, expert interviews, patient and provider focus groups, usability testing) guided the initial concept and design of the resource, and then its refinement. The result was an iPad-based "e-workbook" designed to improve child engagement and provider fidelity in implementation of a best-practice treatment. We are currently conducting a small scale randomized controlled trial to evaluate the feasibility of e-workbook facilitated child mental health treatment with 10 providers and 20 families recruited from 4 local community-based mental health clinics. RESULTS: Usability and focus group testing yielded a number of strong, favorable reactions from providers and families. Recommendations for refining the e-workbook also were provided, and these guided several improvements to the resource prior to initiating the feasibility trial, which is currently underway. CONCLUSIONS: This study aimed to develop and preliminarily evaluate a tablet-based application to improve provider fidelity and child engagement in child mental health treatment. If successful, this approach may serve as a key step toward making best-practice treatment more accessible to children and families. As various technologies continue to increase in popularity worldwide and within the health care field more specifically, it is essential to rigorously test the usability, feasibility, acceptability, and effectiveness of novel health technology solutions. It is also essential to ensure that patients and providers drive decision making that supports the development of these resources to ensure that they can be seamlessly integrated into practice. TRIAL REGISTRATION: Clinicaltrials.gov NCT01915160; https://clinicaltrials.gov/ct2/show/NCT01915160 (Archived by WebCite at http://www.webcitation.org/6cPIiQDpu).
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Disasters have far-reaching and potentially long-lasting effects on youth and families. Research has consistently shown a clear increase in the prevalence of several mental health disorders after disasters, including depression and posttraumatic stress disorder. Widely accessible evidence-based interventions are needed to address this unmet need for youth and families, who are underrepresented in disaster research. Rapid growth in Internet and Smartphone access, as well as several Web based evaluation studies with various adult populations has shown that Web-based interventions are likely to be feasible in this context and can improve clinical outcomes. Such interventions also are generally cost-effective, can be targeted or personalized, and can easily be integrated in a stepped care approach to screening and intervention delivery. This is a protocol paper that describes an innovative study design in which we evaluate a self-help Web-based resource, Bounce Back Now, with a population-based sample of disaster affected adolescents and families. The paper includes description and justification for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this study design include the use of address-based sampling to recruit a population-based sample of disaster-affected adolescents and parents, telephone and Web-based assessments, and development and evaluation of a highly individualized Web intervention for adolescents. Challenges related to large-scale evaluation of technology-delivered interventions with high-risk samples in time-sensitive research are discussed, as well as implications for future research and practice.
Assuntos
Desastres , Família , Internet , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Tornados , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Fator Neurotrófico Derivado do Encéfalo/genética , Criança , Depressão/epidemiologia , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Poder Familiar/psicologia , Polimorfismo de Nucleotídeo Único , Projetos de Pesquisa , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Fumar/epidemiologia , Fatores Socioeconômicos , Transtornos de Estresse Pós-Traumáticos/genéticaRESUMO
Latina/o youth appear to be at significant risk for depression and, of concern, is the high underutilization of mental health services observed in this population. There is a tremendous need for novel intervention methods to better serve the unique needs of this population. This article describes the development of Rise Above (Siempre Sale el Sol), a Web-based, self-help, depression intervention for Latina/o adolescents funded by the National Institute of Mental Health. We applied a cultural adaptation model to an evidence-based depression treatment to reduce potential service barriers and increase the relevance and potential efficacy of the intervention for Latina/o youth. We conducted thematic interviews with 32 national experts to obtain feedback that would inform our application of the cultural adaptation model, the potential efficacy of the intervention, and the feasibility of implementation. Future directions for the evaluation of Rise Above (Siempre Sale el Sol) are described.
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Atitude do Pessoal de Saúde , Depressão/terapia , Transtorno Depressivo/terapia , Hispânico ou Latino , Internet , Psicologia , Assistentes Sociais , Adolescente , Adulto , Criança , Assistência à Saúde Culturalmente Competente/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Autocuidado/métodos , Terapia Assistida por Computador/métodosRESUMO
Post-Traumatic Stress Disorder is a major public health concern in both civilian and military populations, across race, age, gender, and socio-economic status. While PTSD has been around for centuries by some name or another, its definition and description also continue to evolve. Within the last few years, the American Psychological Association has published the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, which includes some major changes in the diagnostic criteria for PTSD. Recent data on epidemiology, etiological theories, and empirically supported methods of treatment, as well as implications for legal processes and criminal justice system personnel, are discussed.
Assuntos
Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/terapia , Terapia Cognitivo-Comportamental , Direito Penal , Exposição à Violência , Humanos , Militares , Fatores de Risco , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/etiologiaRESUMO
National data suggests that teenage girls of Latino descent in the USA are disproportionately affected by HIV, with the US Centers for Disease Control and Prevention reporting the rate of new infections being approximately four times higher compared to White women of comparable age . This paper highlights the need for an effective single-sex HIV-prevention programme for teenage girls of Latino descent and describes the development and preliminary evaluation of Chicas Healing, Informing, Living and Empowering (CHILE), a culturally-tailored, HIV-prevention programme exclusively for teenage girls of Latino descent that was adapted from Sisters Informing, Healing, Living and Empowering (SiHLE), an evidence-based HIV- prevention program that is culturally tailored for African American young women. Theatre testing, a pre-testing methodology to assess consumer response to a demonstration of a product, was utilised to evaluate the relevance and utility of the HIV programme as well as opportunities for the integration of cultural constructs. Future directions for the evaluation of CHILE are discussed.